04/25/2025
Am I being co-managed?
Co-management is an agreement allowed by CMS where an optometrist (OD) has a written agreement to send patients who they determine needs cataract surgery to an Ophthalmologist (surgeon). Immediately after surgery is performed, the patient returns to the referring optometrist for all routine postoperative care. In exchange, up to 20% of the surgical fees can be paid to the referring doctor. By law, this arrangement should NOT be routine, and only used in some cases where it would be a hardship for the patient to travel long distances for postoperative care. There are certainly examples where one surgeon serves a large geographically underserved area and it would difficult for patients to travel 50+ miles several times a month for post surgery care.
Dr Wei does not believe this to be the case Lancaster County, or most of the tri state area. In the last few years, multiple whistleblower lawsuits resulting in millions of dollars of fines for illegal “kickbacks” have been settled due to improper use of comanagment. I have never comanaged and have no plans on comanaging in the future. I believe that the surgeon should be the one who determines when surgery is necessary, which implants are most suitable, and the surgeon should be the ONLY doctor seeing the patient for postoperative care. I would be hard pressed to find an example where the patient is better served by NOT seeing the surgeon after surgery, with over a dozen ophthalmologist in a 10 mile radius, this should NEVER be the case.
Comanagement inevitably clouds the decision making process, especially if the referring doctor only gets paid the comanagment fee if a surgery is performed. All too often, I see patients in their 50s and early 60s come in for second opinions after receiving surgery for minimal or no symptoms. More recently, comanagment fees have unfortunately expanded to include payments to ODs for premium intraocular lens fees, which is both illegal and ethically dubious.
There are certainly excellent ophthalmologists who comanage, but the incentive to perform surgery and upsell premium lenses when a patient is referred in for comanagement certainly exists. Next time you are referred by an optometrist for a cataract evaluation, it may be worth asking if they participate in comanagement and if you’re being sent to the best surgeon or one who participates in their comanagement network.
There are multiple corporations that are profiting millions of dollars on this arrangement, with little transparency to the patients…over an arrangement that’s serves no benefit to patients in an area that is not underserved.
CoFi is a software platform that makes handling co-management payments simpler, more convenient, and compliant for all parties involved – surgeon, optometrist, ambulatory surgery center, and patient.
